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Weighing the cost of written prescriptions

"Four-dollar antibiotics at Walmart? We can’t even buy them for that price, much less store and sell them. We’re shutting down our pharmacy business.”

With the struggling economy and the entrance of large-scale retailers like Walmart, Target and Kroger into the veterinary pharmacy market, many veterinarians are throwing up their hands when it comes to dispensing medications in their own hospitals.

“I just write the prescription and say ‘Here you go,’” said one veterinarian I talked with recently.

A blessing or a curse?

The belief that veterinarians can’t or shouldn’t argue with price savings seems to be spreading. As consumers ourselves, we all know how important it is to do as much with our resources as we possibly can. Why expect our clients to feel differently? Also, from a medical standpoint, those $4 antibiotics can be a godsend in cases where cheap medications allow people to reallocate limited resources toward important diagnostic tests.

But does this scenario mean we should abandon the practice of dispensing drugs at the time of an appointment? Are there drawbacks to a world where veterinarians only write prescriptions instead of dispensing the drugs they want patients to have? How would this model impact the pets we care for?

Here’s what I thought of as I pondered these questions: One morning two years ago, my wife was out of town and I was on my third day alone with our young daughter. I remember frantically trying to get everything done around the house before vaulting into the car and speeding away toward work via the daycare center.

Fifteen minutes into our commute, my daughter asked from her car seat in the back, “Daddy, do I need shoes for school?”

“Of course you do,” I replied distractedly.

In a happy-go-lucky voice she responded, “Well, I don’t haaaaave anyyyyy.”

Our lives are hectic, and we all get overwhelmed sometimes. It’s easy to imagine a pet owner leaving the veterinarian’s office with a script in hand and not getting around to filling it for a few days—or ever. Just look at how many prescriptions for human patients go unfilled.

Adhering to patient care

In 2010, Harvard Medical School published a study tracking more than 195,000 prescriptions. The study found that 22 percent of all prescriptions and 28 percent of new, or first, prescriptions went unfilled. A 2011 study in the American Journal of Medicine put new prescriptions that go unfilled at 24 percent. On the human side, this lack of action by the patient is referred to as “non-adherence.”

Physicians treating human patients are providing prescriptions to alleviate symptoms of illness that people directly experience themselves. Veterinarians, on the other hand, are dealing in medications intended for a silent third party—an animal that is practically incapable of verbalizing discomfort, depression or frustration and cannot speak up for itself. If more than one in five prescriptions—one in four for new treatments—aren’t being filled when a human is affected, then the probability that prescriptions written for pets will go unfilled seems substantial.

According to a May 2010 article in The New York Times, the best answer human medicine has devised for decreasing non-adherence is simplifying the pharmacy process as much as possible. A 2010 article in Health Services Research illustrated this principle at work, showing how only 5 percent of patients enrolled in Kaiser Permanente of Northern California failed to fill their initial prescriptions. While filling prescriptions at Kaiser Permanente pharmacies did offer some cost savings, the difference in adherence appeared to be predominantly based on patients’ ability to retrieve their medications at the same location as, and immediately following, their medical appointment. Given the radical increase in adherence rates when medications are dispensed at the same time and place as the medical exam, it seems irresponsible for us veterinarians to abandon in-house pharmacies without seriously considering the consequences for the pets we treat.

We should always act in the best interest of our patients and provide the best medical care possible. I believe when we have the option to provide medications directly to our clients—whether these medications are for a pet’s acute illness, long-term wellness, or quality of life preservation—then we should do so.

To do this, we need to keep our pharmacies as competitively priced as we can. We should talk to our healthcare teams about adherence and advocate for dispensing medications we trust so that pet owners leave with the appropriate treatments in hand.

The days of using pharmacy markups to subsidize services that we haven’t charged pet owners for may be over (and if this loss drives us to charge more accurately for our knowledge and expertise, maybe that’s a good thing), but providing the best care to our patients should never become a thing of the past. For the sake of our patients, let’s not shut down the in-house pharmacy just yet.